Opioid free onco-anesthesia: Is it time to convict opioids? A systematic review of literature

Thota, Raghu S; Ramkiran, Seshadri; Garg, Rakesh; Goswami, Jyotsna; Baxi, Vaibhavi; Thomas, Mary Ann

doi:10.4103/joacp.joacp_128_19

Cited by 35 publications

(31 citation statements)

References 63 publications

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“…[ 18 ] Therefore, with the appropriate use of propofol, it may be that the use of opioids in the postoperative period may be reduced or removed. [ 19 , 20 ]…”

Section: Discussionmentioning

confidence: 99%

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

Alhayyan

McSorley²,

Kearns³

et al. 2021

Medicine

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There are reports that the use of regional anesthesia (RA) may be associated with better perioperative surgical stress response in cancer patients compared with general anesthetics (GA). However, the role of anesthesia on the magnitude of the postoperative systemic inflammatory response (SIR) in colorectal cancer patients, within an enhanced recovery pathway (ERP), is not clear. The aim of the present study was to examine the effect of anesthesia, within an enhanced recovery pathway, on the magnitude of the postoperative SIR in patients undergoing elective surgery for colorectal cancer. Database of 507 patients who underwent elective open or laparoscopic colorectal cancer surgery between 2015 and 2019 at a single center was studied. The anesthetic technique used was categorized into either GA or GA + RA using a prospective proforma. The relationship between each anesthetic technique and perioperative clinicopathological characteristics was examined using binary logistic regression analysis. The majority of patients were male (54%), younger than 65 years (41%), either normal or overweight (64%), and were nonsmokers (47%). Also, the majority of patients underwent open surgery (60%) and received mainly general + regional anesthetic technique (80%). On univariate analysis, GA + RA was associated with a lower day 4 CRP (≤150/>150 mg/L) concentration. On day 4, postoperative CRP was associated with anesthetic technique [odds ratio (OR) 0.58; confidence interval (CI) 0.31–1.07; P = .086], age (OR 0.70; CI 0.50–0.98; P = .043), sex (OR 1.15; CI 0.95–2.52; P = .074), smoking (OR 1.57; CI 1.13–2.19; P = .006), preoperative mGPS (OR 1.55; CI 1.15–2.10; P = .004), and preoperative dexamethasone (OR 0.70; CI 0.47–1.03; P = .072). On multivariate analysis, day 4 postoperative CRP was independently associated with anesthetic technique (OR 0.56; CI 0.32–0.97; P = .039), age (OR 0.74; CI 0.55–0.99; P = .045), smoking (OR 1.58; CI 1.18–2.12; P = .002), preoperative mGPS (OR 1.41; CI 1.08–1.84; P = .012), and preoperative dexamethasone (OR 0.68; CI 0.50–0.92; P = .014). There was a modest but an independent association between RA and a lower magnitude of the postoperative SIR. Future work is warranted with multicenter RCT to precisely clarify the relationship between anesthesia and the magnitude of the postoperative SIR.

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“…[ 18 ] Therefore, with the appropriate use of propofol, it may be that the use of opioids in the postoperative period may be reduced or removed. [ 19 , 20 ]…”

Section: Discussionmentioning

confidence: 99%

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

Alhayyan

McSorley²,

Kearns³

et al. 2021

Medicine

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“…Finally, the anti-regenerative effect of opioids described in this review is in line with the rethinking around the use of opioids during peri-operative period by anesthesiologists. In order to reduce, or even abolish, the well-known and deleterious side effects of opioids (respiratory depression, hyperalgesia, risk of dependence and chronic use, immunosuppression), opioid-sparing strategies, or strategies dealing with total suppression of opioids (also called opioid-free anesthesia) have emerged [ 109 , 110 , 111 , 112 ]. Opioid-sparing strategies consist in a non-opioid based multimodal pain management associating drugs with different mechanisms of action such as loco-regional techniques (peripheral nerve blocks, epidural analgesia), associated with paracetamol, NSAIDs (non-steroidal anti-inflammatory drugs), α2-agonists, ketamine, magnesium sulfate, intravenous lidocaine, etc., whose aim is to use the lowest effective opioid dose while providing satisfactory analgesia.…”

Section: What Is Known In Human-being?mentioning

confidence: 99%

Tissue Regeneration: The Dark Side of Opioids

Berthézène

Rabiller

Jourdan

et al. 2021

IJMS

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Opioids are regarded as among the most effective analgesic drugs and their use for the management of pain is considered standard of care. Despite their systematic administration in the peri-operative period, their impact on tissue repair has been studied mainly in the context of scar healing and is only beginning to be documented in the context of true tissue regeneration. Indeed, in mammals, growing evidence shows that opioids direct tissue repair towards scar healing, with a loss of tissue function, instead of the regenerative process that allows for recovery of both the morphology and function of tissue. Here, we review recent studies that highlight how opioids may prevent a regenerative process by silencing nociceptive nerve activity and a powerful anti-inflammatory effect. These data open up new perspectives for inducing tissue regeneration and argue for opioid-restricted strategies for managing pain associated with tissue injury.

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“…También se comenta de la hiperalgesia inducida por los opioides como un factor predictor del DPP, razón por la cual deberíamos utilizar menos opioides en el perioperatorio y apoyarnos con mayor frecuencia en otros recursos farmacológicos y procedimientos. Entre ellos: la analgesia multimodal [38], [39], la dexmedetomidina [40], [41], la ketamina [42], la lidocaína intravenosa [43], el sulfato de magnesio [44], la gabapentina [45], [46], la dexametasona [47], el paracetamol [48], los antiinflamatorios no esteroideos (AINE) [49], los inhibidores de la ciclooxigenasa-2 (COX-2) [50], la infiltración de anestésicos locales (bupivacaina liposomal) [51], [52] y los bloqueos en el neuroeje [15], [16], [17] (Tabla 2).…”

Section: E Técnica Anestésicaunclassified

“…Planificar la técnica anestésica de manera individualizada, considerando los factores mencionados anteriormente y la cirugía a realizar. Se deben incluir la analgesia preventiva y la multimodal, considerando el preoperatorio, intraoperatorio y posoperatorio [15], [16], [17], [35]. 7.…”

Section: A Preoperatoriounclassified

Importancia del anestesiólogo en la prevención del dolor crónico

Bolívar¹,

Toro²,

Seijas³

et al. 2021

Rev. chil. anest.

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The development of chronic pain after surgery or persistent postoperative pain is a significant public health problem that affects between 10%-56% of patients undergoing surgical intervention. It produces great restrictions of mobility, limitation of daily activities, dependence on opioids, anxiety, depression, a great alteration of the quality of life and important legal and medical-economic consequences. There is a very close correlation between acute postoperative pain, and persistent postoperative pain. For this reason, pain must be treated effectively in its acute phase to reduce the incidence of chronic pain after surgery. There are risk factors that predispose to its appearance and that must be known by the anesthesiologist. In an individualized and meticulous pre-anesthetic consultation, these risk factors can be detected, as well as the presence of surgical procedures related to chronic pain, with the purpose of the therapeutic approach of the first ones if necessary, and a good planning of the anesthetic and analgesic technique, which reduces the participation of the second, in the chronicity of acute pain. The role of the anesthesiologist in the pre-anesthetic consultation is essential for the planning of preventive and multimodal analgesia that, together with other resources, should reduce the incidence of persistent postoperative pain.

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Opioid free onco-anesthesia: Is it time to convict opioids? A systematic review of literature

Cited by 35 publications

References 63 publications

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

Tissue Regeneration: The Dark Side of Opioids

Importancia del anestesiólogo en la prevención del dolor crónico

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